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The Leeds experience is very different from what has been described. The Leeds Medical Senate has been working together for over two years on how to lead in a system as peers. They have recently established a new Institute for Quality Healthcare in the city, supported by the University of Leeds through the Centre for Innovation in Health Management (CIHM) focusing on improvement in quality care, by enabling clinicians to develop shared expertise in innovation and improvement; and by having a rigorous approach to professional accountability through reviewing variation and decision-making, supported by systematic use of data. This focus will create a culture of continuously providing best quality clinical care at the best value with patients/ service users across Leeds. More about this can be found on our web site www.cihm.leeds.ac.uk